Healthcare Provider Details

I. General information

NPI: 1730391087
Provider Name (Legal Business Name): MRS. ESTHER C OH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14455 SW ALLEN BLVD
BEAVERTON OR
97005-4428
US

IV. Provider business mailing address

2055 SW 198TH AVE
ALOHA OR
97006-2536
US

V. Phone/Fax

Practice location:
  • Phone: 503-526-0651
  • Fax:
Mailing address:
  • Phone: 503-526-0651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDT-DO-758113
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: